Social determinants of iron supplementation among women of reproductive age: a systematic review of qualitative data

Abstract

Iron supplementation for women of reproductive age is a main part of an interdisciplinary strategy recommended for the control and prevention of iron deficiency and the treatment of mild‐to‐moderate iron‐deficiency anaemia. This systematic review reports the findings from a meta‐synthesis of qualitative data concerning the experiences and perceptions of iron supplementation among women of reproductive age and health service providers worldwide. Qualitative systematic review methods were used to conduct a search of published literature, define inclusion and exclusion criteria, appraise quality of studies and extract data on the use of iron supplementation among women of reproductive age. Coding, thematic analysis, reciprocal translation and line of argument synthesis were used to synthesize data. Twelve studies spanning 17 countries met inclusion criteria and were included in the analysis. Seven domains emerged from the review: cultural norms and societal values including explanatory models and medical pluralism; political and socio‐economic circumstances; education and communication; social organization and social relationships; health care access and supplement supply; food and nutrition availability; and adherence. In addition, 16 sub‐domains are highlighted. Connecting review findings to a conceptual framework of social determinants of health highlights salient issues that policy makers must consider when adapting global iron supplementation recommendations to the local context.

Survey of women's perceptions of information provided in the prevention or treatment of iron deficiency anaemia in an Australian tertiary obstetric hospital

“…7,17,19,25 This is compounded by a lack of recognition of the importance of preventing and treating iron deficiency anaemia, congruence of the symptoms of anaemia with advancing pregnancy and the use of natural or traditional remedies. 17 The aim of this study is to establish an insight into the key themes and trends within a tertiary obstetric hospital that includes a population of high, medium and low risk pregnancies. Themes related to the provision of dietary advice and use of oral iron supplements in pregnancy including; barriers to compliance, types of supplements used, and the timing of commencement and cessation of oral iron supplements were explored.…”

“…3,9,10,12,[14][15][16] Gastro-intestinal side effects are frequently cited as a causative factor in reduced compliance to oral iron supplementation in pregnancy. 17,[19][20][21][22][23][24] However studies suggest that education, communication, social and cultural determinants also play a role in lack of motivation to comply with treatment. 7,17,19,25 This is compounded by a lack of recognition of the importance of preventing and treating iron deficiency anaemia, congruence of the symptoms of anaemia with advancing pregnancy and the use of natural or traditional remedies.…”

“…17,[19][20][21][22][23][24] However studies suggest that education, communication, social and cultural determinants also play a role in lack of motivation to comply with treatment. 7,17,19,25 This is compounded by a lack of recognition of the importance of preventing and treating iron deficiency anaemia, congruence of the symptoms of anaemia with advancing pregnancy and the use of natural or traditional remedies. 17 The aim of this study is to establish an insight into the key themes and trends within a tertiary obstetric hospital that includes a population of high, medium and low risk pregnancies.…”

“…There is a lack of consensus in relation to optimal dosing of oral iron supplementation, universal versus targeted treatment or indeed daily versus intermittent versus no routine oral iron supplementation. [10][11][12][13][14][15][16][17][18] The Royal Australian and New Zealand College of Obstetricians and Gynaecologists do not recommend the routine use of iron supplements in pregnancy. 11 The current Australian and New Zealand dietary guidelines recommend an intake of elemental iron per day in pregnancy of 27 mg. 16 Expert recommendations for Asia-Pacific region suggest 80-100 mg elemental iron supplements daily if the haemoglobin (Hb) < 105 g/L and serum ferritin < 20 mg/L.…”

Socioeconomic Determinants of Maternal Anemia: A Disaggregated Level Analysis From Assam, India

“…An intervention to reduce anemia induced by iron deficiency in pregnant women is distribution of iron supplementation. However, policymakers should consider the context specific determinants and sociocultural influences on the implementation of such programme (Nagata et al, 2012). WHO (2015) showed that India contributes one-third of all global maternal deaths (15 percent).…”